Variation in neonatal nurses' conceptions of competence in their practice : implications for the design of learning experiences
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This study has examined the nature of competence in neonatal nursing practice from the perspective of neonatal nurses. It has also explored the type of educational support needed to help new graduates develop more complex and inclusive conceptions of competence in their practice of neonatal nursing. Ideas about being and becoming competent in nursing practice have been informed by conflicting knowledge perspectives. The dominance of traditional research methods that have an underlying dualist ontology and objective epistemology has resulted in educational practices within nursing that separate the worker from the context in which the work occurs. Nurses have made attempts to overcome the limitations of these traditional methods by shifting toward research approaches concerned with the lifeworld of individuals. Much of this newer research however, has not addressed educational practices within nursing. This study is situated within the life-world of neonatal nurses. The non-dualist phenomenographic approach was used to capture and describe variation in the way 20 neonatal nurses conceived of competence in their practice. Analysis of descriptions generated from unstructured interviews revealed four distinctive conceptions of competence in neonatal nursing practice. These conceptions are expressed as hierarchical internally related categories of description, with category IV being the most complex and inclusive. I Managing separate items within the NICU environment according to technology-based policy and procedural rules. II Managing integrated clusters of items within the NICU environment according to technology-based policy and procedural rules. III Managing a support system for the infant and family by using objective sensory observation of the infant to guide the use of policy and procedural rules according to priorities. IV Managing a support system focused on the infant and family by using objective sensory observation of the infant and tacit feelings about the infant arising from variation in the previous experiences of outcome for infant and family to guide and challenge the use of policy and procedural rules. Located within this hierarchy is the critical dimension of individual infant and family response. This response is highly contextual and consists of numerical, sensory and tacit aspects. It is postulated that learning activities should be structured to help new graduates entering the specialty of neonatal nursing to discern and focus on individual infant and family response. As such a learning framework (CONSERVE), based on this critical dimension has been proposed. Structuring learning experiences in this way should enable the development of more complex and inclusive conceptions of competence about the practice of neonatal nursing. Using conceptual variation about competence in neonatal nursing practice highlights the importance of the relationship between the worker and the work. Moreover, it offers an alternative educational approach for new graduates entering the specialty of neonatal nursing that is both relevant and meaningful.
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